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Disaster Medicine (DM) education for Emergency Medicine (EM) residents is highly variable due to time constraints, competing priorities, and program expertise. The investigators’ aim was to define and prioritize DM core competencies for EM residency programs through consensus opinion of experts and EM professional organization representatives.
Methods:
Investigators utilized a modified Delphi methodology to generate a recommended, prioritized core curriculum of 40 DM educational topics for EM residencies.
Results:
The DM topics recommended and outlined for inclusion in EM residency training included: patient triage in disasters, surge capacity, introduction to disaster nomenclature, blast injuries, hospital disaster mitigation, preparedness, planning and response, hospital response to chemical mass-casualty incident (MCI), decontamination indications and issues, trauma MCI, disaster exercises and training, biological agents, personal protective equipment, and hospital response to radiation MCI.
Conclusions:
This expert-consensus-driven, prioritized ranking of DM topics may serve as the core curriculum for US EM residency programs.
By upbringing, family connections, and education, Felix Mendelssohn was ideally positioned to contribute to the historical legacies of the German people, who in the aftermath of the Napoleonic Wars discovered that they were a nation with a distinct culture. The number of cultural icons of German nationalism that Mendelssohn "discovered," promoted, or was asked to promote (by way of commissions) in his compositions is striking: Gutenberg and the invention of the printing press, Dürer and Nuremberg, Luther and the Augsburg Confession as the manifesto of Protestantism, Bach and the St. Matthew Passion, Beethoven and his claims to universal brotherhood. The essays in this volume investigate Mendelssohn's relationship to the music of the past from a variety of perspectives, including the pervasive presence of Bach's music within the larger Mendelssohn family, the influence of Beethoven in the Reformation Symphony, and Mendelssohn's compositions for organ and his relationship to English organs in particular. Together, they shed light on the construction of legacies that, in some cases, served to assert German cultural supremacy only two decades after the composer's death. Contributors: Celia Applegate, John Michael Cooper, Hans Davidsson, Wm. A. Little, Peter Mercer-Taylor, Siegwart Reichwald, Glenn Stanley, Russell Stinson, Benedict Taylor, Nicholas Thistlewaite, Jürgen Thym, R. Larry Todd, Christoph Wolff. Jürgen Thym is Professor Emeritus of Musicology at the Eastman School of Music and editor of Of Poetry and Song: Approaches to the Nineteenth-Century Lied (University of Rochester Press, 2010).
The authors present clinical experience with 28 cases of ruptured anterior cerebral artery (ACA) aneurysms managed personally during a 36 month period, and 10 unruptured ACA aneurysms. The cases included five giant aneurysms and four distal ACA aneurysms. Management strategy was uniform and included early operative intervention (except in the setting of deteriorating neurologic deficit, not attributable to hydrocephalus or hematoma), and vasospasm prophylaxis including calcium channel blockers and hypervolemic hemodilution and arterial hypertension. Modern diagnostic adjuncts including transcranial doppler were used as they became available. Good outcome (outcome grade 1 or 2) was observed at 6 months in 71% (20/28) of ruptured cases and in 90% (9/10) of unruptured cases; fair outcome (outcome grade 3) was observed in 14% (4/28) of ruptured cases and in 10% of unruptured cases; bad outcome (outcome grade 4 or 5) was observed in 14% (4/28) of ruptured cases. There were no instances of rebleeding after admission to the hospital. There was a single mortality in a patient moribund on admission. Delayed ischemic deterioration (DID) was documented in 46% (13 of 28) of the ruptured cases, and was a major source of morbidity in 7 of the 9 instances of fair or poor outcome in the series. Management outcome, including the occurrence of subtle neuropsychological difficulties commonly described in cases with ACA aneurysms, is discussed with relation to the incidence of DID, the clinical course of DID, and the possible impact of various therapeutic strategies.
Although the clinical benefits of dietary supplementation with n-3 polyunsaturated fatty acids (PUFA) has been recognised for a number of years, the molecular mechanisms by which particular PUFA affect metabolism of cells within the synovial joint tissues are not understood. This study set out to investigate how n-3 PUFA and other classes of fatty acids affect both degradative and inflammatory aspects of metabolism of articular cartilage chondrocytes using an in vitro model of cartilage degradation. Using well-established culture models, cartilage explants from normal bovine and human osteoarthritic cartilage were supplemented with either n-3 or n-6 PUFA, and cultures were subsequently treated with interleukin 1 to initiate catabolic processes that mimic cartilage degradation in arthritis. Results show that supplementation specifically with n-3 PUFA, but not n-6 PUFA, causes a decrease in both degradative and inflammatory aspects of chondrocyte metabolism, whilst having no effect on the normal tissue homeostasis. Collectively, our data provide evidence supporting dietary supplementation of n-3 PUFA, which in turn may have a beneficial effect of slowing and reducing inflammation in the pathogenesis of degenerative joint diseases in man.
